Analysis predicts CMS' cardiac bundles to have modest impact

The large majority — 85 percent — of hospitals required to participate in CMS' new cardiac bundled payment model will likely not experience gains or losses larger than $500,000 per year, according to a recent analysis from Avalere.

The analysis assumes no changes in care patterns and is based on current spending levels in data from 2013 and 2014 Medicare Standard Analytic Files. It found the "winners" and "losers" to be fairly evenly distributed, and that the hospitals expected to sustain losses in the program are already spending far above the regional average for cardiac episodes.

Avalere suggests these hospitals may be spending more because they have a sicker patient population or a population that lacks the socioeconomic support system to prevent them from coming back to the hospital for follow-up care.

The analysis also found that for hospitals to achieve savings, they will need to target cost reductions in the inpatient hospital stay for patients who undergo a surgical intervention, such as a coronary artery bypass surgery or a percutaneous coronary intervention. Sixty to 70 percent of spending is incurred during the inpatient portion of the episode for surgical interventions, Avalere found, suggesting device spending will be a top target for those episodes.

For medically-managed patients, such as those who receive drug-based or non-interventional therapy for heart attacks, hospitals should target post-discharge care to achieve savings, according to the report.

"Given the array of new cardiac bundles, there is no magic bullet to achieving savings. Instead, participating hospitals will need to pull multiple levers to drive down costs," Fred Bentley, vice president at Avalere, said in a statement. "They will be working more closely than ever with their physicians to streamline care and promote adherence to clinical guidelines. And they will accelerate the development of high-performance post-acute networks to cut readmissions and achieve efficiencies for their medically-managed heart attack episodes."


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